Hypospadias
Dorsal hooded foreskin chordee abnormal ventral meatus scrotum Hypospadias is a complex of an abnormal ventral meatus, chordee, and a dorsal hooded foreskin. Usually isolated, it can be part of the DSD spectrum.
Incidence: one in 300 live-births (but wide variation from 1 in 110 to 1 in 1,250) Rising incidence Associating with inguinal hernia and hydrocele (~10%), undescended testes (~8%)
Embryology The development of male urethra takes place between the 8th and the 15th week of gestation under the influence of testosterone. Etiology Multifactorial involving genetic, endocrine, and environmental factors.
Genetic Factors Inheritance is unknown.The following facts: Monozygotic twins – eightfold increase in the incidence of hypospadias family history – 8% of fathers and 14% of brothers
Environmental Factors Endocrine Factors Deficient androgenic stimulation Increased maternal progesterone exposure Environmental Factors ↑Incidence of hypospadias and one hypothesis suggests that there is increased maternal exposure to estrogenic substances (contained in pesticides, milk, plastic linings of metal cans, and pharmaceuticals).
Clinical Features Classification Distal (glanular, coronal, and subcoronal) (50%) Middle (distal penile, midshaft, and proximal penile) (30%) Proximal (penoscrotal, scrotal, and perineal) (20%)
Surgery Principles The goal of surgery is to create a cosmetically acceptable penis, which allows normal voiding with a forward stream and normal vaginal penetration.
Meatoplasty and glanuloplasty Skin coverage Preoperative completing the repair of hypospadias before 18 months of age (minimizes psychological impact of genital surgery). Hormone manipulation correction of chordee Urethroplasty Meatoplasty and glanuloplasty Skin coverage
Postoperative Early complications bleeding, hematoma, infection, and breakdown of repair. Long-Term Outcome persistent chordee, meatal stenosis, urethrocutaneous fistula, urethral stricture, and urethral diverticulum. The incidence is highly variable though.
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